Screening for advanced liver disease in type 2 diabetes: time for systematic implementation.

Area of Science:

• Hepatology
• Endocrinology
• Clinical Medicine

Background:

• Metabolic dysfunction-associated steatotic liver disease (MASLD) is a prevalent chronic liver condition globally.
• Patients with type 2 diabetes mellitus (T2DM) face a heightened risk of MASLD progression.
• Systematic liver disease screening in T2DM patients is underutilized in clinical practice despite available non-invasive tools.

Purpose of the Study:

• To evaluate the feasibility and effectiveness of a stepwise screening strategy for MASLD in T2DM patients.
• To support the EASL-EASD-EASO guidelines' proposed screening approach.
• To identify patients with previously unrecognized liver conditions, including advanced fibrosis.

Main Methods:

• Prospective, real-world evidence collection.
• Implementation of a stepwise screening protocol: initial FIB-4 assessment followed by transient elastography.
• Focus on patients with type 2 diabetes.

Main Results:

• The stepwise screening strategy proved feasible and effective in identifying a significant number of T2DM patients with clinically relevant liver disease.
• The approach successfully detected previously unrecognized MASLD and advanced fibrosis.
• A gap between diagnostic evidence and routine clinical practice was identified.

Conclusions:

• The study validates a stepwise screening approach for MASLD in T2DM patients.
• Integrating structured screening into T2DM management is essential, not optional.
• Early detection of MASLD is vital given the evolving treatment landscape and the need to identify high-risk patients.